Provider Demographics
NPI:1679932131
Name:SICELOFF, CARLY (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:
Last Name:SICELOFF
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 S OSCEOLA AVE APT 2104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2825
Mailing Address - Country:US
Mailing Address - Phone:407-538-1633
Mailing Address - Fax:
Practice Address - Street 1:8 S OSCEOLA AVE APT 2104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2825
Practice Address - Country:US
Practice Address - Phone:407-538-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered